Ana Fernández Montes

Nitrofurantoína y enfermedad pulmonar intersticial de rápida resolución

We report the case of a 40-year-old woman diagnosed with interstitial lung disease due to long-term nitrofurantoin therapy. Despite severely distorted bronchiolar architecture and honeycombing confirmed by computed tomography of the thorax, transbronchial biopsy showed a pattern of acute/subacute interstitial pneumonitis and the symptoms and radiographic findings disappeared within 1 month after administration of prednisone. This case shows that nitrofurantoin-induced lung disease may run a benign course and respond favorably to corticosteroids, even when there is radiographic evidence of established lung fibrosis. Transbronchial biopsy might be useful for assessing the reversibility of pulmonary lesions associated with nitrofurantoin.

Rapid Resolution of Nitrofurantoin-Induced Interstitial Lung Disease

We report the case of a 40-year-old woman diagnosed with interstitial lung disease due to long-term nitrofurantoin therapy. Despite severely distorted bronchiolar architecture and honeycombing confirmed by computed tomography of the thorax, transbronchial biopsy showed a pattern of acute/subacute interstitial pneumonitis and the symptoms and radiographic findings disappeared within 1 month after administration of prednisone. This case shows that nitrofurantoin-induced lung disease may run a benign course and respond favorably to corticosteroids, even when there is radiographic evidence of established lung fibrosis. Transbronchial biopsy might be useful for assessing the reversibility of pulmonary lesions associated with nitrofurantoin.

Nota ClínicaEnfermedad de Rendu-Osler con afectación hepática: primer trasplante en EspañaRendu-Osler disease with hepatic involvement: First transplant in Spain

BACKGROUND AND OBJECTIVE Rendu-Oslers disease (RO) is a rare systemic vascular disorder due to a fibrovascular dysplasia in the endothelium of vessels. Recurrent epistaxis is the main clinical manifestation, but arteriovenous malformations (AVMs) can involve many organs, including the liver. Hepatic involvement can develop refractory heart failure due to large shunts between the hepatic veins and the hepatic artery. Embolization and hepatic artery ligation have also demonstrated to reduce cardiac output in RO, but these therapeutic options have significant morbidity and complications such as necrosis or liver failure. CASE REPORT We report the case of a 48 years old woman diagnosed in 1987 with RO and significant hepatic involvement, with multiple fistulas between veins and hepatic artery. In the following years she developed progressive heart failure that limited her quality of life. RESULTS She was admitted on more times with heart failure and her dyspnea worsened progressively up to NYHA IV. At this time, an echocardiograph control showed an output cardiac about 10.6l/min. On December 2004, although the medical treatment, the worsening of the patient went on, so we finally decided to conduct a liver transplant that resolved the symptoms and the hyperdynamic circulation. Despite the fact that liver transplant has become without doubt into the best treatment for these patients in the last years. CONCLUSIONS This is the first one done in Spain. There are different therapies available for these patients, but the indications for transplantation are greater each day, mainly due to the risks of the other options. Currently the stated guidelines are heart failure and portal hypertension refractory to medical treatment. So in these situations, liver transplantation should be proposed in the early stages of the disease and may be the only viable option.

Enfermedad de Rendu-Osler con afectación hepática: primer trasplante en España

BACKGROUND AND OBJECTIVE Rendu-Oslers disease (RO) is a rare systemic vascular disorder due to a fibrovascular dysplasia in the endothelium of vessels. Recurrent epistaxis is the main clinical manifestation, but arteriovenous malformations (AVMs) can involve many organs, including the liver. Hepatic involvement can develop refractory heart failure due to large shunts between the hepatic veins and the hepatic artery. Embolization and hepatic artery ligation have also demonstrated to reduce cardiac output in RO, but these therapeutic options have significant morbidity and complications such as necrosis or liver failure. CASE REPORT We report the case of a 48 years old woman diagnosed in 1987 with RO and significant hepatic involvement, with multiple fistulas between veins and hepatic artery. In the following years she developed progressive heart failure that limited her quality of life. RESULTS She was admitted on more times with heart failure and her dyspnea worsened progressively up to NYHA IV. At this time, an echocardiograph control showed an output cardiac about 10.6l/min. On December 2004, although the medical treatment, the worsening of the patient went on, so we finally decided to conduct a liver transplant that resolved the symptoms and the hyperdynamic circulation. Despite the fact that liver transplant has become without doubt into the best treatment for these patients in the last years. CONCLUSIONS This is the first one done in Spain. There are different therapies available for these patients, but the indications for transplantation are greater each day, mainly due to the risks of the other options. Currently the stated guidelines are heart failure and portal hypertension refractory to medical treatment. So in these situations, liver transplantation should be proposed in the early stages of the disease and may be the only viable option.

Round Pneumonia: A Rare Cause of Multiple Pulmonary Nodules

psoriasis cannot be ruled out as the cause of the lung disease; however, the patient had a history of treatment with methotrexate and cyclosporine and during hospital admission she was given many drugs which could have caused the lung affection, amongst which was acitretine, which has a well-documented link with interstitial damage. In the case of the patient we are reporting, she did not receive any medicine to justify the symptoms, and all the bacteriological studies performed were also negative. Likewise, the response to steroids alone was very good from both the point of view of the lungs and the skin, so we inferred that there was a clear association between the 2 entities, and this is the first reported case which links, beyond all doubt, organising pneumonia with psoriasis. To conclude, we must say that psoriasis patients can have lung manifestations and that organising pneumonia may be just another kind of lung affectation caused by this skin disease.

Artropatía neuropática del hombro por siringomielia

Figura 2. Varon de 75 anos que ingreso por cuadro de 2 meses de evolucion de dolor a la altura del hombro derecho y p erdida progresiva de fuerza y movilidad del brazo. En la reconstruccion osea tridimensional mediante TC multicorte (fig. 1) se apreciaba la destruccion completa de la cabeza humeral derecha. Una RMN medular (fig. 2) demostro la existencia de una cavidad siringomi elica que se extendia desde C1 hasta T7. La artropatia neurop atica de Charcot es un proceso destructivo articular de etiologia desconocida. Las causas m as frecuentes en los paises desarrollados son la diabetes y el alcohol, y el tobillo es la articulacion involucrada en la mayoria de los casos. La afectacion del hombro es rara y, cuando ocurre, con frecuencia se asocia a la siringomielia.

Neumonía redonda: una causa poco habitual de nódulos pulmonares múltiples

psoriasis, que se hallaba en una fase de exacerbación, fue una neumonı́a organizada confirmada por anatomı́a patológica, que respondió de manera excelente al tratamiento con esteroides, al igual que el cuadro de psoriasis. Después de una exhaustiva búsqueda sólo hallamos la publicación de 2 casos de psoriasis con neumonı́a organizada. En uno se constató una infección aguda por citomegalovirus, por lo que se asumió como secundaria a este virus. En el otro caso es difı́cil precisar, aunque no se descarta, que la causa de esta enfermedad pulmonar fuera la psoriasis, ya que la paciente tenı́a el antecedente de haberse tratado con metotrexate y ciclosporina y que en el transcurso de la hospitalización se le administraron múltiples fármacos que pueden haber producido la afectación pulmonar, entre ellos acitretin, cuya vinculación con el compromiso intersticial se halla bien documentada. En el caso de la paciente que comunicamos, no recibió ningún fármaco que justificara el cuadro, como ası́ también fueron negativos todos los estudios bacteriológicos realizados. Asimismo, la respuesta a esteroides, sin ninguna otro fármaco, fue muy buena desde el punto de vista pulmonar como cutáneo, por lo que inferimos que existió una clara asociación entre las 2 entidades y que serı́a el primer caso comunicado que vincula, sin dudas, la neumonı́a organizada con la psoriasis. En conclusión, debemos decir que la psoriasis puede cursar con manifestaciones pulmonares y que la neumonı́a organizada puede ser una forma más de afectación pulmonar de esta enfermedad. Bibliografı́a